Why Telehealth Physical Therapy Works (Yes, Really!)

Telehealth physical therapy is effective, affordable, and better for you than you know. This is backed up by the evidence as well as personal stories.

Why Telehealth Physical Therapy Works (Yes, Really!)

Telehealth physical therapy / physiotherapy mainstreamed its way into our lives -- alongside other telehealth services -- in 2020.

Yet four years later, skepticism about telehealth continues, particularly when it comes to physical therapy.

Many folks think telehealth physical therapy is:

Not as effective as in person physical therapy, and
More expensive than in person physical therapy

Neither are true.

For others, telehealth is a turn off more because of what it isn’t.

People LOVE the hands-on stuff (“manual therapy”) that can come with in person physical therapy. This post will also address some of the limits of manual therapy.

What is telehealth?

Telehealth is any form of medical care that is transmitted long distance. (source).

In theory it could be provided via phone. But these days “telehealth” usually implies a one on one chat through secured video conferencing with a licensed healthcare practitioner.

So: How effective could physical therapy by video really be?

The answer is “Very”.

Here are just a few of the reasons why telehealth physical therapy works:

Patient empowerment
Convenience, more flexible scheduling (lunch break PT anyone?)
Accessibility if you have mobility challenges, like crutches or a wheelchair
Comfort of your own home
Cost - less childcare expenses, less transit costs
Insurance coverage is the same!
Able to work with the exact practitioner you want to see, regardless of location (within the limits of their license)
Reduced stress (arriving / parking / etc, elimination of travel time)
Easier scheduling > could mean more consistent PT sessions
Reduced risk of infection, which is incredibly important to caregivers, those with autoimmune issues, anyone planning to take a big trip and more

Telehealth sessions can also be combined with or alternated with in person sessions.

Wellilo also offers shorter (30 minute) telehealth sessions that are a great adjunct to regular 1 hour PT visits as a quick review of exercises or for home ergonomic set up or any other quick issue that has come up.

Let’s break down a select few of the benefits above:

Cost

According to an instagram poll I ran, a surprising number of people think that telehealth physical therapy is more expensive than in person sessions.

It’s not.

By law, in the District of Columbia, telehealth services must be reimbursed at the same rate as in person services.

“(a) A health insurer offering a health benefits plan in the District may not deny coverage for a healthcare service on the basis that the service is provided through telehealth if the same service would be covered when delivered in person.” (source)

Even Medicare offers full reimbursement for telehealth services without geographic restriction at least through the end of 2024.

Wellilo also offers telehealth sessions at a 20% discount compared to in person sessions.

Empowerment: The Power is with the Patient

Physical therapy as a profession is rooted in the empowerment of its patients. What happens after and between sessions is at least as important as the breakthroughs happening within the session.

There is a lot to say about this, especially how it compares to services like chiropractic care and massage therapy, but you can also take it as a stand alone statement.

Physical therapists are highly skilled:

Movement prescribers,
Ergonomic specialists, and,
Lifestyle magicians. We are able (just using words!) to understand lifestyle factors that may be contributing to someone’s pain or discomfort. This might include sleep or sitting position, protein intake, frequency of movement, tweaks within how you move (shoes, gait mechanics, types of exercise, and more). Simple changes can create massive results.

All three of these skills are easy to put into action through telehealth.

They all empower the patient and the effects last well beyond one session.

Whether the positive effects noticed during a physical therapy session are sustained is everything. Focusing on what benefits persist helps patient and practitioner alike to know if we are on the right track and helps us in getting to the root cause of the issue.

Manual Therapy - less empowering?

Compared to exercise prescription, manual therapy is more of a one directional type of intervention.

It keeps the power in the hands of the practitioner (the physical therapist) and the only way to receive more manual therapy is to see the physical therapist again.

If exercises, ergonomics and shifts in lifestyle alone make you feel better day to day, you may need fewer sessions overall or finish physical therapy faster through telehealth than through in person.

There is absolutely a case for manual therapy being used as a bridge to help someone move better and be more empowered in the long run. But it must be used judiciously alongside exercise prescription.

Test and Re-Test

For those still skeptical about prescribing movement through video, let me introduce the basis for all good physical therapy. It’s the concept of “test-retest”.

Test-retest requires first knowing the positions or activities that can aggravate pain or bring up discomfort. These -- as you may already know well -- do not require a practitioner to be in the room with you.

Test-Retest is the GOLD standard for whether any physical therapy technique actually works in person or on telehealth. It can be done within one session or over the course of multiple sessions (or both).

It goes like this:

TEST

Find the uncomfortable or painful position. For example: you might feel sharp pain bending over to tie your shoes. Briefly, without causing too much intense sensation, test that position to see if the pain gets provoked with that movement today. Perhaps you measure how far your fingers reach down your leg when the pain starts. That becomes your test and re-test activity.

INTERVENTION

Then you do something that -- based on your evaluation -- should help. In physical therapy, we call this an “intervention”.

For example: for many people with back pain they feel less pain after completing repetitions of either extension (Backbending) or flexion (rounding) of the spine.

RE-TEST

Backbend ten times, then re-test tying your shoes. Less pain? We are on the right track. No change, move on to the next idea.

Also: try doing your physical therapy home exercises 3-4 times a week for two weeks. Feel better next session? That is our “re-test” and it is how we know that we are on the right track.

Physios have an unlimited fount of ideas for interventions, especially movement ideas able to be shared via video.

Testing and re-testing not only guides the practitioner with real life evidence, it can offer genuine hope for the patient who -- after the intervention -- experiences measurable relief.

It is also a way to practice physical therapy with integrity and collaboration, rather than a top-down “I think you need this” kind of way.

Test-retest should happen during both in person and online sessions.

Yes, during an in-person session, sometimes interventions will be hands-on things that cannot be done via video. But hands-on interventions may have lost some of their shine in recent years based on the evidence.

What does the Evidence say about Hands-on Interventions?

This subject is controversial, and a bit heartbreaking for many physical therapists.

Hands-on methods, like soft tissue mobilization, joint mobilization, manual traction, fascial release and more, remain part of the national standard of physical therapy academic programs.

Many, if not most, physical therapists have also invested thousands of dollars in continuing education methods that require using your hands. (That is certainly true for me).

But it’s also true that the published research looking at the effectiveness of manual physical therapy treatments shows them to be essentially the same and / or inferior to exercise for the long term.

Anecdotally speaking, hands on, “manual” physical therapy can offer amazing results, and I am a huge fan of it (just as I am a fan of telehealth).

It’s true that you won’t experience the magic of dry needling, meniscal milking, or targeted trigger point release via telehealth (although you can get to some of those trigger points yourself by being taught self massage over video).

But teaming up with a physical therapist who “gets” you, whose advice you will trust, and who knows your unique sport or movement practices, will be able to help you more through video than multiple sessions with an in person physical therapist who focuses on soft tissue massage most of the time.

Do you get pain only in the transition from one yoga pose to another? Why would you see anyone other than a physical therapist with a background in yoga -- even if that session has to be through telehealth?

Evidence for Telehealth and Systematic Reviews for Exercise-Only Physio

One of the highest forms of scientific evidence is a systematic review. Systematic reviews consolidate high quality published research to answer a specific question. The Cochrane Review is a highly esteemed research entity that specializes in systematic reviews.

Here is what their 2021 systematic review on low back pain shows.

“People receiving exercise therapy rated their pain on average 15 points better and their disability 7 points better, on a scale of 0 to 100, three months after the start of treatment compared to people who had no treatment, usual care or placebo. Exercise is probably more effective for pain (35 studies, 2746 people) and probably slightly more effective for disability (38 studies, 2942 people) than no treatment, usual care or placebo at all follow-up periods.” (source)

A 2022 Cochrane Review looked at exercise therapy vs. exercise therapy plus additional treatments (like manual therapy) for knee osteoarthritis:

“Additional therapies plus exercise therapy do not appear to offer meaningful improvements in pain, function, quality of life or overall change for people with hip or knee osteoarthritis compared with sham additional therapies plus land-based exercise therapy; or in pain, function, quality of life or changes on X-rays when compared with exercise therapy only.” (source)

More evidence

“Reports, studies, and surveys have demonstrated telehealth provides opportunities to make health care more efficient, better coordinated, convenient, and affordable.

Telehealth can also help address health income and access disparities in underserved communities by removing location and transportation barriers, unproductive time away from work, childcare expenses, and so on.

Despite evidence showing high-quality outcomes, satisfaction, and success rates (e.g., 95% patient satisfaction rate and 84% success rate in which patients were able to completely resolve their medical concerns during a telehealth visit), nationwide adoption of telehealth has been quite low due to policy and regulatory barriers, constraints, and complexities.” (source)

Personal Experience

I’ve used telehealth for myself for physical therapy needs, for women's health consults, and once when I was away on a beach vacation, scraped my knee badly on rocky sand and later noticed signs of infection. Each time it was tremendously helpful, convenient, and as affordable or more affordable than in person sessions.

Sustainable Physical Wellbeing

Whether you choose telehealth or in person physical therapy sessions for your course of care, only one thing matters at the end of the day:

What makes you feel better in the long term?

Finding ways for people to move efficiently, safely and with less pain is key.

Telehealth is an under-appreciated and powerful way to make this happen.

So if you have been putting of getting physical therapy care because of lack of time, difficulty scheduling, the need for childcare, or costs associated with back and forth, I hope you’ll give telehealth a try.

To book a telehealth session with a Wellilo practitioner, check out our booking site: https://wellilo.janeapp.com.

To read the 55+ five star reviews of our clinic and services (including what people have to say about telehealth), simply type "Wellilo" into google.com

And if you have questions about physical therapy or our other wellness and movement services, shoot an email to [email protected].

Categories: : Physical Therapy